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LJ=Tj()% NU I <br /> OigIGINAL-. ATER WELL DRILLERS REP( � Do Not Fill lis <br /> File Original,Duplicate and Triplicate with the (sections 70749,7077,7072,Water code) l�?e 14 281 <br /> REGIONAL WATER POLL <br /> STATE OF CALIFORNIA State We11 No._. <br /> CONTROL BOARD 11 �" 7 Other Well No... L <br /> (lesrrt appropriate wwswbrr) Z • �` -�----� ' <br /> r 1) OWNER: (11) WELL LOG: <br /> Name 10 Total depth ft. Depth of completed well ft. <br /> Address �/� l ��,(,�ytr�A Formation: Dncribe by dolor,rbsraeter,size of Material, l Structure. <br /> (2) LOCATION OF WELL: <br /> Owner's number,if any— �� .a•�� A ` A <br /> n .. n y /1 1/4,1.Y "i;__ /I <br /> R.P.D.or Jviet No. �- ` ot .• •, - <br /> r <br /> 257 F <br /> 0 e- <br /> (3) TYPE OF WORK (check): -Z/2 <br /> New well 2 Deepening ❑ Reconditioning ❑ Abandon ❑ �G l(Z�/trQ 7�n i c•+ = = j _A L <br /> If abandonment,describe material and procedure in Item 11. "1 ' a ter r70 <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: l� o� f f cw.Av�",' d <br /> Domestic [Industrial ❑ Municipal ❑ Rotary Q� <br /> Irrigation ❑ Test Well [:1 Other 1:1 Dug <br /> ❑ <br /> Dug Well ❑ <br /> (6) CASING INSTALLED: If gravel packed <br /> SINGLE Qa-'DOUBLE Gage <br /> q" Diameter from to <br /> From Oft.to �Zff�jj/73iam. f `yWal1 of Bore 9��ft. f 7���ft. „ <br /> Type and size of shoe or well ring Size of gravel: �-�� . •• <br /> Describe joint 7_4/—. <br /> (7) PERFORAT3QNS• �-- <br /> Type of perforator used c.�GL�C�•.e_-� („�-►�,,,Cr/�,- .. , <br /> SIZe of perforations /�! ! in.,length,by _,;I in. <br /> From er rt, /�' lg ft. Perf.per row l��/ Row+per it. <br /> (8) CONSTRUCTION: , <br /> Was a surface sanitary seal provided? [!rYea ❑ No To what depth i ft. •• „ <br /> Were any strata sealed against pollution? W-Y. ❑ No If yes,note depth of strata . . <br /> From ���ft.tn_�S"� it. <br /> Method of Sealing t 1 / L meek sorted 9# Completed <br /> (9) WATER LEVELS: WELL DRILLEM STATEMENT: ✓ <br /> This well was drilled under my jurisdiction and this report is true to the best o• <br /> Depth at which water was fin .ire found ' 2 ft• my knowledg and belief. / <br /> S"Wing level before perforating / fc. NAME /�J� �.0�•efM f�r�i / :iIK i <br /> anding level after perforating1 •� ft. f crson, ,or corperatioa, Trp,d or Ducted; <br /> l+ <br /> a Address 3 <br /> (10) WELL TESTS: 1 <br /> Was a pump tut made? ❑ Yet V1.4- If 70,by whom? <br /> [SIGNED _.- ----- <br /> ------- <br /> —•••--- <br /> Yield: J- gal./min. with .�- ft.draw down after !' bro. Tell DON <br /> ..._ y ,t <br /> Temperature of water '-7ru a chemiml mai ns model �' v - w ^_ _ i _ <br /> << 7 J .n [r•,l,r' Lscense Na__:'�'-^.�.J _..-------- Dated---------------c �"'�----------- <br /> Was <br /> ------•Was electric log made of well? 0 Yes o ! aseea s-e+seat ouiro®sro DWR FORM NO. 246 IR[V. 3•54, <br />